Impact of armed conflict on health professionals’ education and training in Syria: a systematic review

Abstract

ObjectivesTo provide an overview of the holistic impact of the armed conflict on medical education and health professionals’ training (MEHPT) in Syria.SettingSyria is a country which underwent an armed conflict for 10 years and suffered from the weaponisation of health.MethodsA mixed-methods systematic review including quantitative, qualitative, mixed-methods and textual literature between 2011 and 2021 including papers on the Syrian MEHPT undergraduate and postgraduate education and training personnel (including medicine, dentistry, pharmacy, nursing, midwifery and allied health professionals). The electronic search was conducted in October 2018 in Embase, Global Health, Medline, PsycINFO, Web of Science, PubMed, Scopus, CINAHL and grey literature. And an update to the search was conducted in August 2021 in PubMed, Google Scholar and Trip database.OutcomesThe impact of conflict on the MEHPT system, personnel, experiences, challenges and channels of support.ResultsOf the 5710 citations screened, 70 met the inclusion criteria (34 quantitative, 3 qualitative, 1 mixed-method, and 32 reports and opinion papers). The two major cross-cutting themes were attacks on MEHPT and innovations (present in 41% and 44% of the papers, respectively), followed by challenges facing the MEHPT sector and attitudes and knowledge of trainees and students, and lastly health system and policy issues, and narrating experiences.ConclusionConflict in Syria has politicised all aspects of MEHPT. Influenced by political control, the MEHPT system has been divided into two distinguished geopolitical contexts; government-controlled areas (GCAs) and non-GCAs (NGCAs), each having its characteristics and level of war impact. International and regional academic institutes collaboration and coordination efforts are needed to formulate educational platforms using innovative approaches (such as online/blended/store-and-forward/peer-training/online tutoring) to strengthen and build the capacity of the health workforce in conflict-affected areas.

Medical education in Syria at a time of crisis: Analysis of the results of the knowledge‐based National Medical Examination

“…15 Further repercussions that seem to be present in countries like Ukraine, Libya, Yemen and Iraq included displacement, work and study restriction and psychological stress among others. [5][6][7]16,17 Several factors may be responsible for the deterioration in academic performance of final year medical students at a time of crisis, such as the deteriorating services and infrastructure, inaccessibility to learning resources, 3,18 and the sharp decline in the numbers of available teaching personnel because of displacement or immigration. 4 A recent review has highlighted the fact that the Syrian conflict has exaggerated the previously existing challenges which faced medical education in the country, including the lack of governmental funding towards development and research, the low-quality teaching and training programs, absence of research funding, absence of health information and record keeping data, and the increased costs of learning and studying resources.…”

“…4 A recent review has highlighted the fact that the Syrian conflict has exaggerated the previously existing challenges which faced medical education in the country, including the lack of governmental funding towards development and research, the low-quality teaching and training programs, absence of research funding, absence of health information and record keeping data, and the increased costs of learning and studying resources. 3 In addition, feelings of insecurity and the high psychological distress 19,20 to which medical students were exposed are likely to have impaired their adaptability and resilience, and to set back their motivation and learning capabilities. 21,22 Such disturbances were reported during crises in Pakistan where increased incidents of depression and anxiety were noted among displaced communities, with a negative impact on academic achievements.…”

“…2 The impact of war or conflict on medical education and health professionals' training (MEHPT) is a complex and multifaceted phenomenon that has not been adequately explored in the literature. 3 Previous studies have mainly focused on the challenges and barriers faced by MEHPT personnel and students in conflict-affected areas, such as attacks on health facilities, educational disruption, resource loss, psychological distress, and brain drain. 3,4 A scoping review by Dobiesz et al identified 56 studies involving 17 wars and 17 countries, and found that the most common barriers were insecurity, displacement, lack of resources, and psychological distress.…”

“…3 Previous studies have mainly focused on the challenges and barriers faced by MEHPT personnel and students in conflict-affected areas, such as attacks on health facilities, educational disruption, resource loss, psychological distress, and brain drain. 3,4 A scoping review by Dobiesz et al identified 56 studies involving 17 wars and 17 countries, and found that the most common barriers were insecurity, displacement, lack of resources, and psychological distress. 4 Additionally, the impact of war or conflict on medical education has been studied in various countries and regions, such as Iraq, 5 Libya, 6 Yemen, 7 sub-Saharan Africa, 8 and the Middle East.…”

“…11 The impact of this crisis on medical education in Syria has not been studied satisfactorily as most existing reports were merely descriptive studies of certain aspects of the calamity. 3,12,13 Therefore, there is a need for a quantitative and comparative analyses of the academic performance of medical students across different universities and time periods in Syria. Such analyses may provide valuable insights into the challenges and opportunities for improving medical education in Syria and other countries facing similar crises.…”